<%@ page language="java" import="java.util.*" pageEncoding="UTF-8"%>
<%@ include file="/WEB-INF/com/com.jsp"%>

<!DOCTYPE HTML PUBLIC "-//W3C//DTD HTML 4.01 Transitional//EN">
<html>
  <head>
    <base href="<%=basePath%>">
     <title>add</title>
  </head>
  
  <body>
  
  <div class="panel admin-panel">
<div class="panel-head" id="add"><strong><span class="icon-pencil-square-o"></span>报销信息登记</strong></div>
<div class="body-content">
    <form method="post" class="form-x" action="<%=basePath%>/mxb/MxbBxRegister_bxadd.action">  
		<input type="hidden" value="${mxbBxRegister.bxUserId}" name="bxUserId" /> 
		<input type="hidden" value="${sessionScope.sysUser.userId}" name="bxWorkId" /> 
		<div class="form-group">
		        <div class="label">
		          <label>报销人名称：</label>
		        </div>
		        <div class="field">
		          <input type="text" class="input w50" readonly="readonly" value="${userRealNameY}" />
		          <div class="tips"></div>
		        </div>
		</div>    
		<div class="form-group">
        <div class="label">
          <label>报销机构名称：</label>
        </div>
        <div class="field">
          <input type="text" class="input w50"  readonly="readonly" value="${bxPlaceId}" name=""   />
          <div class="tips"></div>
        </div>
      </div> 
      <div class="form-group">
        <div class="label">
          <label>参合年度：</label>
        </div>
        <div class="field">
          <input type="text" class="input w50" readonly="readonly" value="${caheDateY}" />
          <div class="tips"></div>
        </div>
      </div>
       <div class="form-group">
        <div class="label">
          <label>可用报销金额：</label>
        </div>
        <div class="field">
          <input type="text" class="input w50"  readonly="readonly" value="${bxAllMoneyY}" name="bxAllMoneyY"  />
          <div class="tips"></div>
        </div>
      </div>
      <div class="form-group">
        <div class="label">
          <label>报销金额：</label>
        </div>
        <div class="field">
          <input type="text" class="input w50" value="${mxbBxRegister.bxMoney}" name="bxMoney"/>
          <div class="tips"></div>
        </div>
      </div>
     
       <div class="form-group">
        <div class="label">
          <label></label>
        </div>
        <div class="field">
          <button class="button bg-main icon-check-square-o" type="submit"> 提交</button>
        </div>
      </div>
    </form>
  </div>
</div> 
</body>
</html>
